基于单指数、双指数和拉伸指数模型的 DWI 研究：区分胶质母细胞瘤患者的肿瘤进展与假性进展。

Differentiating tumour progression from pseudoprogression in glioblastoma patients: a monoexponential, biexponential, and stretched-exponential model-based DWI study.

机构信息

Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, 550002, China.

Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China.

出版信息

BMC Med Imaging. 2023 Sep 11;23(1):119. doi: 10.1186/s12880-023-01082-7.

BACKGROUND

To investigate the diagnostic performance of parameters derived from monoexponential, biexponential, and stretched-exponential diffusion-weighted imaging models in differentiating tumour progression from pseudoprogression in glioblastoma patients.

METHODS

Forty patients with pathologically confirmed glioblastoma exhibiting enhancing lesions after completion of chemoradiation therapy were enrolled in the study, which were then classified as tumour progression and pseudoprogression. All patients underwent conventional and multi-b diffusion-weighted MRI. The apparent diffusion coefficient (ADC) from a monoexponential model, the true diffusion coefficient (D), pseudodiffusion coefficient (D*) and perfusion fraction (f) from a biexponential model, and the distributed diffusion coefficient (DDC) and intravoxel heterogeneity index (α) from a stretched-exponential model were compared between tumour progression and pseudoprogression groups. Receiver operating characteristic curves (ROC) analysis was used to investigate the diagnostic performance of different DWI parameters. Interclass correlation coefficient (ICC) was used to evaluate the consistency of measurements.

RESULTS

The values of ADC, D, DDC, and α values were lower in tumour progression patients than that in pseudoprogression patients (p < 0.05). The values of D* and f were higher in tumour progression patients than that in pseudoprogression patients (p < 0.05). Diagnostic accuracy for differentiating tumour progression from pseudoprogression was highest for α(AUC = 0.94) than that for ADC (AUC = 0.91), D (AUC = 0.92), D* (AUC = 0.81), f (AUC = 0.75), and DDC (AUC = 0.88).

CONCLUSIONS

Multi-b DWI is a promising method for differentiating tumour progression from pseudoprogression with high diagnostic accuracy. In addition, the α derived from stretched-exponential model is the most promising DWI parameter for the prediction of tumour progression in glioblastoma patients.

背景

研究单指数、双指数和拉伸指数扩散加权成像模型衍生参数在鉴别胶质母细胞瘤患者肿瘤进展与假性进展中的诊断性能。

方法

本研究纳入了 40 例经病理证实的在完成放化疗后出现增强病变的胶质母细胞瘤患者，这些患者随后被分为肿瘤进展和假性进展。所有患者均接受了常规和多 b 扩散加权 MRI 检查。比较肿瘤进展组和假性进展组之间单指数模型的表观扩散系数（ADC）、真扩散系数（D）、假性扩散系数（D*）和灌注分数（f）、双指数模型的分布式扩散系数（DDC）和体素内异质性指数（α）。使用受试者工作特征曲线（ROC）分析不同 DWI 参数的诊断性能。使用组内相关系数（ICC）评估测量的一致性。

结果

肿瘤进展患者的 ADC、D、DDC 和 α 值均低于假性进展患者（p<0.05）。肿瘤进展患者的 D和 f 值高于假性进展患者（p<0.05）。α（AUC=0.94）区分肿瘤进展与假性进展的诊断准确性高于 ADC（AUC=0.91）、D（AUC=0.92）、D（AUC=0.81）、f（AUC=0.75）和 DDC（AUC=0.88）。